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The CRAFT Approach: Encouraging Healthy, Constructive, Positive Changes for Your Family

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By Jeff Foote, Carrie Wilkens and Nicole Kosanke

“My son is using drugs and it’s wrecking our family. I’ve tried to talk to him, but he just gets mad and then we just stop talking. What should I do?”

We often receive this kind of call here at Center for Motivation & Change (CMC). It’s a terrible call because of the anguish involved. It’s also a wonderful call, because we have the tools needed to help. A call like this provides our CMC clinicians the opportunity to invite the family member to learn about CRAFT.

Community Reinforcement and Family Training, or CRAFT, is an approach for families who have a loved one struggling with substances but who is not really interested in making changes or getting help. CRAFT is about learning a different method to communicate with and support your loved one. It’s about taking care of yourself, while also learning how to interact with your loved one in a way that increases the likelihood of making a real change.

The old method – either help them, or help yourself by distancing yourself from them – was never a choice you should have to make. CRAFT teaches you a series of strategies such as:

• Understanding how to communicate positively (even when things aren’t going so well)
• Using positive reinforcement to focus on what is working, while allowing for the bad stuff they are doing to impact them
• Taking real steps and developing real awareness of what it means to take care of yourself, not as an afterthought, but as a priority for the whole family

Parents have been told a number of things that are neither helpful nor practical: “Let them hit bottom, they have to figure it out for themselves”; “There’s nothing you can do, helping them is enabling their use and means you are ‘co-dependent.’” These “tough love” messages are often excruciating for many parents.

The good news? You can help your loved one without taking those steps. CRAFT works to change your interactions with your loved one so that sober behavior is more rewarding to them than continued alcohol and drug use.

CRAFT is “menu-driven.” This means that different components and procedures are selected from the CRAFT “menu” based on the family’s particular needs. Where the treatment starts depends on the substance user’s behavior, severity and openness to change. It also depends on your emotional state, experience and history as a family.

CRAFT research (and our clinical experience) has demonstrated that by learning skills and understanding what motivates your child, positive change can occur. Evidence shows that positive outcomes occur at a much higher rate with the CRAFT approach than with other, more well-known approaches, such as either the 12-Step Anon programs or Intervention approaches.

Why? Probably because CRAFT is positive, aimed at encouraging healthy, constructive changes, and is focused on helping your child develop or re-develop a life. In addition, CRAFT is a behavioral approach, interested in changing behaviors (theirs and yours), not just talking about them. And as we mentioned, it is geared toward improving your life as well. Research studies repeatedly find that family members feel much better throughout the CRAFT process, whether or not their loved one ultimately gets into treatment. Best of all, using the CRAFT approach, the substance user in the family seeks treatment at a rate of about 65-75%, 2-3 times higher than interventions or Anon approaches.

CRAFT works. It may require work, practice, stumbles, practice and more practice. But CRAFT also teaches you that “you can help.”

Perhaps most importantly, the skills, strategies and insight you gain through CRAFT are built for the long haul: what you will learn now will remain applicable beyond your current situation; it’s not just useful when “trying to get him to say yes to treatment.” Saying yes matters, but what matters more are the changes you can make in your family, because these changes are the ones that provide the fuel for lasting change, not just for putting out the immediate fire.

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The Center for Motivation & Change is a unique, NYC-based private group practice of dedicated clinicians and researchers providing non-ideological, evidence-based, effective treatment of addictive disorders and other compulsive behaviors. CMC’s treatment approach is informed by a strong commitment to both the humanity and the science of change, providing a unique, compelling, and inspiring environment in which to begin the process of change. Staffed by a group of experienced psychologists, CMC takes pride in their collective record of clinical research and administrative experience but most of all are driven by an optimism about people’s capacity to change and a commitment to the science of change.

 Learn more about CMC and read about our unique and effective approach to treating addictive disorders, and meet CMC’s directorial staff and clinical staff. To find more resources for families, please see our Parent’s 20 Minute Guide, and our Family Blog.  And to learn more about CRAFT, see our CRAFT Family Services page. Find us on Facebook  and Twitter for additional content and the latest updates.

 

4 Responses to this article

  1. Patti Herndon / August 20, 2013 at 4:58 pm

    Hi StageMom,

    I’m sorry that I had not been aware of your visit to this Intervene blog sooner. Your son is so fortunate to have you advocating for him, supporting him. Keep it up. Be very wary of following advisements from people that would have you ‘walk away’, ‘disconnect’, ‘detach’, etc. These kinds of advisements are probably well intended…but they are misguided.

    Don’t let others negative energies about your son’s challenge of addiction rob you of your ‘knowing’. Listen to your instincts…and LEARN about ‘the stages of change’ model. Google it. Start reading. It will start to make a lot of sense as you process the information.

    SMART Recovery is an excellent learning and support resource that utilizes the stages of change model in their frame of support. I hope you have had opportunity to visit their online Friends and Family support group. It’s very user friendly. SMART Recovery (Self Management and Recovery Training)and SMART Recovery Friends and Family has advantages as a peer support model in that it ‘teaches’ about how the change process occurs/how recovery occurs for individuals. It utilizes that learning to support parents, friends and other loved one’s in discovery of a menu of options in problem solving for ‘their own’ individual circumstances. Rather than wasting precious energy repeating depletive, dead-end mantras about all the things ‘we can’t control’, ‘didn’t cause’ and ‘can’t cure’; frames of support that ‘teach’ about how the change process occurs in individuals -and how we can use that learning to discover what it is we CAN do- supports momentum in recovery…harnesses our sense of empowerment and fosters our sense of self efficacy. This kind of learning inspires our creative problem solving ability. Change takes time. And the time it takes for each individual is just that -’individual’. Recovery/sustainable change takes as long as it takes. It’s a process. And, we ‘all’ possess an innate ability to problem solve for our circumstances. With the right kind of support, we can build coping muscles for the journey. And with better coping, comes increasing hope.

    Status quo, stagnate philosophies about how we should or shouldnt respond to addiction fail to teach us what it is we CAN do. Strides in healthy change occur because of what we ‘can do’, ‘did do’, ‘continue to do’…

    Hope is a clinical and critical component in recovery/in change. Having hope, being skilled at maintaining hope in the beyond difficult journey of addiction, helps us manage anxiety and stress regarding the journey. Hope let’s us see the ‘big picture’. It helps us see down the road…helps us see ourselves and our child choosing to live an increasingly healthier life.

    When we consistently model ‘that’ sense to our son/daughter as they journey through addiction, we are helping them develop ‘their own’ sense of hope. When we model -talk about, interact with our son/daughter in fear, frustration, anger, resentments, shame about the journey of addiction -to the exclusion of/or in imbalance of modeling hope and self efficacy- we are robbing our kid of their ability to hope for themselves. “Where there is hope there is life”. We get that backwards in addiction, sometimes. Gotta have the hope part ‘first’.

    Our culture is lagging behind in terms of understanding and applying what science has revealed in more recent history about how people achieve healthy change/how people recover. We are largely stuck in old ways of thinking, feeling and speaking about addiction, and about those who are challenged by it. We don’t realize as a culture that, in many ways, those status quo philosophies and approaches are contributing to the lack of progress for countless individuals and families, as well as perpetuating the toxic state of stigma that swirls around these old notions about addiction…notions that would have us believing that addiction is the product of moral failing and character deficit. And we know that simply is not the truth.

    Addiction is a pattern of coping that has developed, has been learned…It can be ‘unlearned’. It takes time. It takes us educating ourselves about ‘the change process’. It takes the building of coping muscles and the development of a self-sustainable, (but, also, encouraged-by-our-significant others) sense of hope about the innate potential we have in problem solving for our circumstances.

    Personal growth…It’s the path we are all on from the moment we take our first breath. I think each of us has a separate map, but our roads/our paths to it intertwine and cross over and over. We are meant to journey together. No one was ever encouraged in their own growth by being/feeling alone in their struggle. We need one another to hang in there as we make our way.

    Addiction is the journey. Recovery is the destination.

    Hang in there with him, Mom. Godspeed and ever-increasing peace to you, your son, and your family. If you make your way back here…If I can support you in any way, please don’t hesitate to contact me. patti.herndon@gmail.com

  2. StageMom / July 23, 2013 at 11:07 pm

    Patty…I’m speechless and have felt alone with mixed emotions on this very subject a BATTLE inside that no other parent of an addict dare speak of!!! I am going to research this SMART and CRAFT and make my voice heard!

    I kept telling myself something is not right here!!!! I agree about detrimental detaching/neglect! It is my own thought that today there is a “new Bottom” and that’s the GRAVE!!! What ever happen to “unconditional love?” These drugs are different these days!

    I already lost one son and NOW almost another (my younger son 24 yrs) to this rising epidemic of oxy/heroin… He has just finished detox and this TIME I’m doing something different! I agree fully with “sabotage of the spirit, and a detriment to the development of an empowered sense of hope” and this is the first time I’ve heard this!!! I’m furious I knew I was on to something in my heart and head. My family just announced they are done with him and will not go to rehab/family or visit him! I yelled at them grow up people he’s a lost kid GET OVER IT! It’s all our responsibility to get our butts in there and encourage him!!!!!! Get over how hurt you are…yeah! he lied to you!? stole from you…. Here! educate yourself on addiction!!!! It’s all part of the game!…still I am the only one who will visit him! sad thing is He’s a movie star and you’d probably know him! but when he’s high and on the big screen he’s everyone’s BEST FRIEND, grandson, cousin…errr!! It’s time for me to start researching this NEW APPROACH thank you!

  3. Patti Herndon / June 21, 2013 at 8:31 pm

    “Evidence shows that positive outcomes occur at a much higher rate with the CRAFT approach than with other, more well-known approaches, such as either the 12-Step Anon programs or Intervention approaches.”

    I’m a parent of a son in long term recovery and a counseling student trained in Motivational Interviewing. It was not until we backed away from implementing status quo advisements, rooted in traditional/12 step philosophy, and began applying treatment/communication/relational dynamic strategies based on CRAFT and MI, that our son began to gain clear momentum in recovery –establishing and building on ‘his own’ reasons for change, rather than us arguing with one another about why he should stop using substances to cope.
    I realize now, 15 years later, how we upped our son’s risk of harm by allowing well-intended parent peers, we engaged for help, (as well as some clinicians who were not trained beyond 12-step), to influence us to ‘detach’ in attempt to avoid ‘enabling’ and ‘co-dependency’.

    When we have a son/daughter with any other chronic disease/condition, ‘detaching’ would simply be considered neglect. If we truly wish to see addiction viewed as/treated as any other chronic condition or disease, we need to stop approaching -speaking/thinking about- substance use disorder as a product of deficit in character, i.e. a selfish person, a dishonest person, a person lacking spiritual/valued-based anchoring.

    Stigma -shame, blame, judgment, scapegoating, stereotyping- is sometimes at the root of the social cueing that has dominated for decades, whereby parent peers and even some clinicians are automated to advise/’encourage’ other parents to “do nothing more than pray” or “there’s always the homeless shelter”, or “you can do nothing until he/she admits that they are ‘an addict’”, or “if you help them in any way, you’re an enabler parent in denial”. And, so much of the time these perspectives are occurring and being perpetuated by us/by our culture…and we are completely unaware we are part of the problem of stigma.

    It’s time to call out these approaches for what they are: sabotage of the spirit, and a detriment to the development of an empowered sense of hope.

    Hope is a critical clinical component in recovery. You’re not going to achieve a sense of hope by someone encouraging that as a parent “you can’t ___, or “you didn’t ___”, or that “you can do nothing for your child but pray. Prayer is powerful. But we need more. We need education/menu of options in order to achieve healthy coping onto gains in sustainable recovery, little by little. And that’s how change occurs…little by little. Change is a process. Each individual’s change process is unique to the individual circumstances. Let’s engage those resources that empower us, that encourage us to learn, hope, change and grow. That’s how we become the best advocates we can possibly be on behalf of ourselves, our son/daughters/our families…our communities.

    Self Management and Recovery Training (SMART Recovery) and SMART Recovery Friends and Family is a peer support resource that utilizes these current, evidence-based strategies.

    Thank you for this great article! It’s so nice to see this direct language of CAN on Intervene Blogging! I’ve been patiently, hopefully waiting ;-) Keep up the CANs Intervene!

    Addiction is the journey. Recovery is the destination.

  4. steve castleman / June 19, 2013 at 4:15 pm

    One thing that can help parents is a better understanding of the science of addiction. If parents know addiction is a brain disease, they may be more able to get past their anger and frustration and better able to participate in valuable programs like CRAFT.

    For a not-for-profit website that discusses the science of substance use and abuse in accessible English (how alcohol and drugs work in the brain; how addiction develops; why addiction is a chronic, progressive brain disease; what parts of the brain malfunction as a result of substance abuse; how that malfunction skews decision-making and motivation, resulting in addict behaviors; why some get addicted while others don’t; how treatment works; how well treatment works; why relapse is common; what family and friends can do; etc.) please click on http://www.AddictScience.com.

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